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To evaluate whether apparent diffusion coefficient (ADC) of diffusion-weighted imaging (DWI) is able to investigate the histological features of soft tissue tumours. We reviewed MRIs of soft tissue tumours performed from 2012 to 2015 to calculate the average ADCs. We included 46 patients (27 male; mean age: 57 years, range 12–85 years) with histologically proven soft tissue tumours (10 benign, 2 intermediate 34 malignant) grouped into eight tumour type classes. An experienced pathologist assigned a semi-quantitative cellularity score (very high, high, medium and low) and tumour grading. The t test, ANOVA and linear regression were used to correlate ADC with clinicopathological data. Approximate receiver operating characteristic curves were created to predict possible uses of ADC to differentiate benign from malignant tumours. There was a significant difference (p

Magnetic resonance imaging (MRI) is a pivotal radiological examination in clinical practice, being widely applied for musculoskeletal examinations. In this setting, strict adherence to standardized protocol is crucial to increase diagnostic performance and minimize variability among different diagnostic centres and readers. The aim of this paper is to provide standardized technical recommendations for musculoskeletal MRI scans proposed by the Italian College of Musculoskeletal Radiology. These recommendations are designed to give a uniform application of MRI protocols over the national territory, to increase reproducibility and improve diagnostic performance.

Introduction Musculoskeletal Soft Tissue Tumours (STT) are frequent heterogeneous lesions. Guidelines consider a mass larger than 5 cm and deep with respect to the deep fascia potentially malignant. Contrast Enhanced Ultrasound (CEUS) can detect both vascularity and tumour neoangiogenesis. We hypothesised that perfusion patterns and vascularisation time could improve the accuracy of CEUS in discriminating malignant tumours from benign lesions. Materials and methods 216 STT were studied: 40% benign lesions, 60% malignant tumours, 56% in the lower limbs. Seven CEUS perfusion patterns and three types of vascularisation (arterial-venous uptake, absence of uptake) were applied. Accuracy was evaluated by comparing imaging with the histological diagnosis. Univariate and multivariate analysis, Chi-square test and t-test for independent variables were applied; significance was set at p Results CEUS pattern 6 (inhomogeneous perfusion), arterial uptake and location in the lower limb were associated with high risk of malignancy. CEUS pattern has PPV 77%, rapidity of vascularisation PPV 69%; location in the limbs is the most sensitive indicator, but NPV 52%, PPV 65%. The combination of CEUS-pattern and vascularisation has 74% PPV, 60% NPV, 70% sensitivity. No correlation with size and location in relation to the deep fascia was found. Conclusion US with CEUS qualitative analysis could be an accurate technique to identify potentially malignant STT, for which second line imaging and biopsy are indicated in Referral Centers. Intense inhomogeneous enhancement with avascular areas and rapid vascularisation time could be useful in discriminating benign from malignant SST, overall when the lower limbs are involved.

Musculoskeletal tumours are rare, with a wide variety of presentations. Three “up to date” topics are focused, two in imaging, one in management. Contrast Enhanced UltraSound is promising also as a guidance for tru-cut biopsy and magnetic resonance with functional imaging studies (DCE, DWI, MRI-spectroscopy) could help in diagnosis and treatment. Piedmont and Valle d’Aosta Oncological Network could be an organizational model for musculoskeletal tumours in an interdisciplinary organization.

The aim of this study was to evaluate whether there exists a characteristic distribution pattern of vessels within neurinomas that may be used to characterise this type of lesion by employing a contrast-specific ultrasound technique.Between January 2003 and May 2010, 66 suspected neurinomas were evaluated according to their sonographic features (solid fusiform mass with well-defined margins located in direct continuity with the nerve that was not always discernible and heterogeneous as a result of the presence of small cystic areas or calcifications). The lesions were examined using a sonographic contrast medium consisting of sulphur hexafluoride microbubbles and equipment with dedicated contrast-specific software [contrast tuned imaging (CnTI)]. Of these lesions, five were excluded from the analysis because the definitive diagnosis was not available (in two cases, the follow-up was still in progress, whereas in the remaining three, there was no follow-up). Our study, therefore, is based on 61 surgically excised lesions that were confirmed to be neurinomas by histology, which is regarded as the gold standard.In 41/61 cases (67.2%), we identified an enhancement pattern that we termed reticular owing to the interweaving of blood vessels, of which two subtypes were identified depending on whether the interwoven vessels were densely or sparsely packed: loose-knit reticular in 18/41, and tight-knit reticular in 23/41. In 20/61 (32.8%) cases, we observed a vascular pattern of diffuse heterogeneous enhancement, which was divided into two subtypes based on the presence of one (7/20) or more (13/20) avascular areas.Results showed that all neurinomas studied could be divided into two groups according to the type of enhancement pattern observed: reticular or diffuse heterogeneous.

The objective of this study was to evaluate the concordance of US and contrast-enhanced US (CEUS) with CT in the assessment of solid organ injury following blunt trauma. Patients underwent complete US examination, including free fluid search and solid organ analysis. CEUS followed, using low-mechanical index techniques and SonoVue. CT was performed within 1 h. Among 156 enrolled patients, 91 had one or more abnormalities (n = 107) at CT: 26 renal, 38 liver, 43 spleen. Sensitivity, specificity, and accuracy for renal trauma at baseline US were 36%, 98%, and 88%, respectively, after CEUS values increased to 69%, 99%, and 94%. For liver baseline US values were 68%, 97%, and 90%; after CEUS were 84%, 99%, and 96%. For spleen, results were 77%, 96%, and 91% at baseline US and 93%, 99%, and 97% after CEUS. Per patient evaluation gave the following results in terms of sensitivity, specificity and accuracy: 79%, 82%, 80% at baseline US; 94%, 89%, and 92% following CEUS. CEUS is more sensitive than US in the detection of solid organ injury, potentially reducing the need for further imaging. False negatives from CEUS are due to minor injuries, without relevant consequences for patient management and prognosis.

Soft tissue tumours (STT) require accurate diagnosis in order to identify potential malignancies. Preoperative planning is fundamental to avoid inadequate treatments. The role of contrast-enhanced computed tomography (CT) for local staging remains incompletely assessed. Aims of the study were to evaluate CT accuracy in discriminating active from aggressive tumours compared to histology and evaluate the role of CT angiography (CTA) in surgical planning. This retrospective cohort series of 88 cases from 1200 patients (7 %) was locally studied by contrast-enhanced CT and CTA in a referral centre: 74 malignant tumours, 14 benign lesions. Contrast-enhancement patterns and relationship of the mass with major vessels and bone were compared with histology on surgically excised samples. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were evaluated in discriminating active from aggressive tumours. Sensitivity in differentiating aggressive tumours from active lesions was 89 %, specificity 84 %, PPV 90 %, NPV 82 %. The relationship between mass and major vessels/bone was fundamental for surgical strategy respectively in 40 % and in 58 % of malignant tumours. Contrast-enhanced CT and CTA are effective in differentiating aggressive masses from active lesions in soft tissue and in depicting the relationship between tumour and adjacent bones and major vessels. • Accurate delineation of vascular and bony involvement preoperatively is fundamental for a correct resection. • CT plays a critical role in differential diagnosis of soft tissue masses. • Contrast-enhanced CT and CT angiography are helpful in depicting tumoral vascular involvement. • CT is optimal for characterization of bone involvement in soft tissue malignancies.

Fat transfer is commonly used to fill loss of volume in depressed scars caused by trauma, deep burns or surgery. The aim of the study is to investigate the degree of fat graft take through evaluation of the microcirculation of grafted autologous adipose tissue using contrast-enhanced ultrasonography.From 2010 to 2012 at the Department of Plastic and Reconstructive Surgery of the Traumatological Center in Turin, a study population was selected from patients with surgical indications for autologous fat transfer for scar correction. For each surgical procedure patients underwent a clinical and sonographic evaluation before and after intervention (at 1 month and 3 months).Out of a total of 28 interventions, 24 showed a good result; defined as improvement of the scar, and confirmed by the presence of vascularization in the transplanted tissue. In 4 cases, there was a lack of blood supply at the first evaluation but an initial good clinical scar correction. The absence of blood vessels was confirmed at 3 months accompanied by complete resorption of the transferred fat with a failure of good clinical outcome.Contrast-enhanced ultrasonography was able to evaluate the microvasculature of adipose tissue after fat transfer. Due to this characteristic, it allows to monitor and predict the take of adipose tissue and provide realistic and early information on the clinical outcome of fat transfer.

Summary Sports injuries may cause traumatic and degenerative injuries at both an amatuer and professional level and are caused by direct athletic gestures or biomechanical modifications triggered by repetitive movements. Because of its particular morphology, the ankle is often involved in these injuries, particularly in soccer, athletics and basketball. The most common pathologies involve sprains, but there may also be osteochondral fractures, impingement syndrome, stress fractures or tendon injuries. There is a complex diagnostic cycle which must include an evaluation of the clinical history, specific information from specialists and diagnostic imaging. Nowadays, there are many and varied methodologies available that vary in sensibility and specificity. The correct diagnostic imaging cycle must be followed, integrating the methodologies in such a way as to obtain the most reliable diagnostic data as possible.

Introduction: The so-called knee impingement syndromes are very frequently reported in both professional and amateur sportsmen. Purpose: The objective of our study was to classify the most frequent knee changes responsible for such syndromes considering both pathology and diagnostic work-up. Material and methods: Our patients complained of aspecific symptoms related to articular meniscal, ligament or cartilage, conditions. The site of pain was periarticular and there was no apparent sign of acute traumatic events. All individuals, aged 16–55, practised sports at different levels and women were the majority of the sample. The study was carried out from 1995 to 1997 and all the medical records presented in occasion of the sports-medicine check-up were reviewed. Results: The sites of symptom onset were divided into medial, lateral, anterior and posterior. For each of them the most frequent conditions which could be defined as impingement syndromes, were defined paying particular attention to the possible methods of diagnosis useful to classify the disorder. As for anterior syndromes, patellofemoral disorders were the most frequent findings. They were associated with either incorrect torsion movements of the lower limbs or local dysplasia. Alterations in the single skeletal and cartilage structures were reported. Always referring to anterior syndromes, Hoffa's fat pad imflammation and the jumper's knee were a less frequent finding. As for posterior impingement syndromes, the most frequent abnormalities involved the insertional tract of the midcalf muscle associated with bursa reaction and insertional popliteus hypertrophy. As for medial syndromes, the most frequent abnormality involved the parapatellar synovial fold whose symptoms can be often mistaken for a meniscal injury. Less frequent is the involvement of the 'pes anserinus' tendinitis and the insertional enthesopathy of the semimembranosus muscle. As for lateral syndromes, the phlogistic involvement of the distal insertional tract of the broad fascia tensor tendon with bursa reaction is very frequently reported, while the inflammation of the popliteal tendon and of the femoral bicipital tendon is less common. Conclusions: Although less frequent than meniscal and ligament injuries, impingement syndromes must be taken into due consideration when looking for knee disorders resorting to different diagnosis methods. Diagnostic imaging is very useful in this regard as it allows a proper and correct diagnosis procedure for any single condition.

Our purpose in this chapter is to establish a linear, step-by-step procedure for use in musculoskeletal diagnostic imaging of elderly patients, describing some of the clinical peculiarities of old age and suggesting some specific technical choices. The authors start from the first symptoms that lead elderly patients to imaging, that is, pain (acute, breakthrough, or chronic), related to a traumatic lesion or a nontraumatic disease, to reach a clinical flowchart (algorithm). Consequently, the authors propose three flowcharts, one for axial trauma, one for appendicular skeletal trauma, and one for nontraumatic skeletal diseases to describe the procedures for diagnostic imaging in the elderly. The goal of this step-by-step procedure is to aid the diagnostician in sorting through the possible diagnoses and, if possible, to reach the correct diagnosis, and so approach the best therapy.

I rapporti tra attivita sportiva e osteoporosi non sono scontati sia in senso positivo che negativo. L’uso di intense contrazioni muscolari di alcuni tipi di sport da un lato dovrebbe stimolare l’osso a incrementare la resistenza lungo le linee di forza, come dimostrerebbero i valori di densita ossea nei sollevatori di peso, ma carichi ripetuti e troppo frequenti possono in altri sport determinare fratture da stress, che sottintendono come la densita ossea non sia consona alle necessita richieste da una certa attivita e cioe che non si siano sviluppati i meccanismi di adattamento che ci si aspetterebbe. Inoltre, talune attivita richiedono un peso corporeo minimo ottenibile solo con una dieta rigorosa, che talvolta determina nei soggetti giovani di sesso femminile modificazioni ormonali con amenorrea secondaria e riduzione della densita ossea.

Our study aimed to assess the role of magnetic resonance imaging (MRI) in the characterisation of musculoskeletal tumours and to identify specific perfusion patterns for the different tumours.Between January 2003 and September 2005, we evaluated the conventional and perfusion MRIs of 39 patients with musculoskeletal tumours. Dynamic MRI was performed with a 1.5-T and 1.0-T MRI unit before and after the intravenous administration of contrast material, using dedicated phased-array coils appropriate for the region to be studied and fast and ultrafast consecutive sequences. Postprocessing was done on an independent workstation (Advantage Windows, GE Medical System), with Functool (GE) software, which allowed a quantitative evaluation of enhancement as a function of time. The results were compared with the histopathological diagnoses obtained by biopsy or surgery.The lesions identified in the 39 patients included 23 soft tissue tumours (12 benign, 11 malignant) and 16 bone tumours (ten benign, six malignant). Comparing the time-intensity diagrams of lesions of the same histological type, we found typical enhancement patterns for some bone tumours only, especially for bone, cartilaginous, fibrohistiocytic and pseudoinflammatory lesions. No typical enhancement pattern could be detected for any of the histological types of soft tissue tumour. Analysis of the slope of the time-intensity curves has a sensitivity and specificity of 64%-58% for soft tissue tumours and 86%-67% for bone tumours in determining the biological aggressiveness of the lesions.Perfusion MRI had moderate sensitivity and specificity in the differential diagnosis between lesions with high or low biological activity. Only in a few cases was it possible to find some correlation between perfusion patterns and lesion histology. The slope values should therefore be used in combination with conventional spin-echo images and other imaging and clinical data in order to narrow the field of the possible differential diagnoses and reliably predict the nature of the lesion.

The objective of this study was to evaluate the role of magnetic resonance imaging (MRI) and ultrasonography (US) in the diagnosis of traumatic muscle injuries.From June 2003 to June 2004, 81 football players with a history of traumatic muscle injuries to the lower limbs were examined. US was performed shortly after the trauma (from 6 to 72 h afterwards) and MRI within a maximum of 5 days.MRI revealed 26 minor and 55 major traumas. MRI and US showed complete concordance in 71 patients (site, type and extent of injury). US produced ten false negative results, including six minor lesions and four major lesions. US had a sensitivity of 87.65% in the correct identification of muscle injuries; its sensitivity was 92.72% for major lesions and 76.92% for minor lesions, 57% for delayed-onset muscle soreness (DOMS), 80% for lengthenings, 83% for contractures, 84% for strains, 87.5% for mild contusions and 100% for severe contusions.US is the first-line technique for examination of muscle injuries. MRI is able to reveal lesions that may be missed at US and provide a more accurate assessment of site and extent of injury.

The purpose of this study way to assess the value of contrast enhanced gray-scale ultrasound (CEUS) in detection of vascularity in joints of patients with rheumatoid arthritis (RA) in a multicenter study of the International Arthritis Contrast Ultrasound (IACUS) study group. We assessed 113 joints in 113 patients (44 men, 69 women; mean age 51+/-14 years) with clinical diagnosis of RA. Gray-scale ultrasound (US), power Doppler US (PDUS) and CEUS, using a low mechanical index US technique, was performed. CEUS was done by bolus administration of the contrast agent SonoVue (Bracco, Milan, Italy) with a dosage of 4.8-ml SonoVue flushed with 10 ml saline. Detection of joint vascularity was performed for differentiation of active synovitis from inactive intra-articular thickening (synovitis/effusion). With the use of US and PDUS, active synovitis could be differentiated from inactive intra-articular thickening in 68/113 joints (60.1%), whereas CEUS enabled differentiation in 110/113 (97.3%) joints (p0.0001). Thickness measurement of active synovitis was significantly improved after contrast administration (p=0.008). In conclusion, CEUS improves the differentiation of active synovitis from inactive intra-articular thickening. Since CEUS has shown an ability to improve assessment of vascularized synovial proliferation in RA affected joints, this technique may have further potential in monitoring therapy.

To propose a graded classification of lesions of the fibrocartilaginous glenoid labrum in traumatic dislocations of the shoulder, based on arthro-MRI in sagittal-oblique views.Seventy-one patients with histories of chronic post-traumatic shoulder instability were studied from May 2000 to May 2001. MR images were obtained using superconducting magnets operating at 1 and 1.5 Tesla, with a dedicated shoulder coil. The study was carried out in combination with arthrography, with axial sections oriented perpendicularly to the longitudinal axis of the glena, oblique coronal sections parallel to the course of the supraspinous muscle tendon and oblique sagittal sections with axis parallel to the longitudinal axis of the glena.In one case an anatomical variant was found (Buford complex). In 18 patients a simple fissuration of the fibrocartilaginous glenoid labrum was found, whereas 28 patients displayed more extensive lesions affecting the middle-inferior portions of the labrum. In 15 patients the lesion extended to the middle-superior third of the glena, involving the middle glenohumeral ligament. In 9 cases, in addition to a complete lesion of the labrum, with typical "bucket-handle" appearance, a lesion of the superior and middle glenohumeral ligaments was also observed.In traumatic shoulder dislocations it is essential to provide the surgeon with precise information regarding the location, extension and degree of damage to the capsule, ligaments and especially the labrum of the glenohumeral joint. On the basis of the results obtained in the sagittal-oblique sections we propose an MR-arthrography classification dividing lesions of the fibrocartilaginous labrum into 4 grades.

The ankle impingement syndrome depends on many factors (fiber or bone production changes) manifested with pain and limited range of movement of the tibiotarsal joint. We tried to classify the various causes and sites of impingement syndromes with MRI.A cohort of 42 selected patients underwent a 2-year orthopedic follow-up. All patients were examined with MRI using both a low field permanent dedicated magnet at 0.2 Tesla (Artoscan, Esaote Biomedica, Genoa, Italy) and a high field General Electric unit at 1.0 T; sequences and views were chosen according to the condition studied. Gd-DTPA was administered in 26/42 patients. All patients underwent arthroscopy.Twenty-one patients had positive symptoms in the anterolateral region of the ankle and 14 of them had lateral changes. In 13 patients we found fibrous tissue (meniscoid lesion) or hypertrophy of the synovial tissue. An intra-articular body was observed in one patient. An osteophyte was found in 5 patients at the level of the anterior margin of the tibia, with the presence of reactive synovial tissue. Three of 18 patients with posterior pain had a traumatic injury of the posterior exterior tubercle of the astragalus, 7 had a fracture of the os trigonum and 2 had small sclerotic foci formations in calceneal site; chondropathy with sclerosis of subchondral bone was diagnosed in 2 patients. Posterior bone impingement was observed in the remaining 4 patients. Two patients had synovial impingement in posterolateral site. A posterior plica synovialis was seen in 1 patient. Fibrotic-scar tissue was observed in one case, in the subtalus region (impingement synovialis subtalaris). The administration of intra-articular Gd-DTPA provided better definition of the fibrous tissue and the intra-articular free bodies. Modest vascular enhancement of the tissues was seen in 9 of 8 patients receiving the contrast agent. In the other two cases, where signal tissue was low, no signal enhancement was observed after the contrast agent administration.Based on integrated MR, clinical and arthroscopic findings we classified tibiotarsal joint impingement syndromes into three types, namely: 1) bone impingement; 2) fibrous impingement where both site and grade are considered; 3) impingement synovialis subtalaris.MRI appears to be a fundamental diagnostic imaging tool in depicting and detailing the various patterns and sites of the impingement syndrome of the tibiotarsal joint thus allowing an objective classification.

The hand and wrist are common sites for trauma, resulting in various bony, capsular, ligamentous and tendinous injuries. Traumatic injuries of the wrist are very frequent and occur at every age. Some lesions happen characteristically in a specific decade of life. Bone mineralization, which could be considered age-related, and ligamentous resistance and compliance, together with the mechanism of the trauma determine the resulting lesion [1-5]. Thus, metaphyseal fractures and slipping epiphysis typically occur in children. Both carpal dislocations and fracture-dislocations typically occur in young adults. Fractures, dislocations and fracture-dislocations of the distal extremity of radius and ulna usually occur in the elderly.

The term “impingement” means the presence, in the joint area, of a formation originating from one of the components in that same joint and limiting function by effecting the biomechanics of movement. The impingement syndrome in the shoulder is defined as friction between skeletal components due to articular disequilibrium caused by injury to the tendons and ligaments.

In the study of osteoarticular conditions, MRI makes a definite diagnostic improvement, even though some problems are still to be solved. Thus, on the basis of their arthrographic experience, the authors experimentally applied this technique to MRI, to assess the actual feasibility of MR arthrography. Forty-three patients were selected to undergo MR examinations after the intraarticular injection of 15-20 ml paramagnetic contrast agent (Gd-DTPA), with 0.25% saline solution. Before MR arthrography every patient underwent a baseline MR arthrography exam. Normal anatomy was better depicted with MR arthrography. In all cases, even small lesions and other structural changes missed at baseline MRI were demonstrated. Therefore, in agreement with previous arthrographic and CT arthrographic reports, we believe MR arthrography to be a simple technique improving MR diagnostic capabilities in selected cases.

10055 Background: STS are 1% of malignant tumors in adults. Rarity, heterogeneity in presentation, low expertise in primary care physicians (PCP) or in general hospitals, organisation problems in specialized centers may cause a delay in both diagnosis and treatment. Aim of this study is to acknowledge the barriers to optimal care and the consequences of the delay on prognosis. Methods: Patients with STS of the extremities, trunk, retroperitoneum treated and followed from 1999 to 2011 by the same multidisciplinary group were included. Time and pattern of symptoms onset, anatomic site, tumor volume, patients’ age, gender and home, interval between diagnosis and surgical treatment or neoadjuvant chemotherapy; time to start adjuvant RT or CT were considered in a univariate - multivariate analysis. Results: 449 adult patient (53% F, 47% M, median age 55 years) were followed for a median time of 116.38 months. 65.7% of STS were at the extremities, 17.6% retroperitoneal, 16.7% at the trunk wall. Median volume at diagnosis was 8 cm for trunk and extremities; 15 cm for retroperitoneum. Commonest histologies: liposarcoma. 18.2%; leiomyo 16.8%; mixofibro 13.6%. Increasing mass, pain, and abdominal disconfort were the main revealing signs of diseases. Median time of delay were: from onset of symptom to first medical visit 68 days for trunk and extremities, 82 for retroperitoneum; 104 days from symptoms to histological diagnosis; 129 days from symptoms to start of therapy. Time to surgery after definitive diagnosis was 12 days in extremities and 21 in abdomen. Adjuvant CT started 22 days after surgery for extremities, 25 in trunk, 35 in retroperitoneum. RT initiated after 78 days. Longer delay in treatment lead to worse prognosis: MS 89.95 months if delay was > 3 months; 190.40 months if wait was < 3 months (p 0.007). Conclusions: Low self consciousness of the patient; misdiagnosis or inadequate approach in general hospitals; late referral to specialized centres are 75% of the cause of wasted time. Organization problems at the referral Centre concur for 25% of delay. Guidelines implementation and educational programme among general population and PCP are necessary.

10086 Background: Neoadjuvant chemotherapy (NACT) has a well established role in multidisciplinary treatment of soft tissue sarcomas (STS). Unfortunately no sure predictive factors have been identified in order to screen those patients who are going to benefit from NACT. Topoisomerase IIα (topo IIα) is a positive target for anthracyclines. Bcl-2 is a molecular target for alchilants. P-glycoprotein gp170 is a member of multidrug resistance (MDR) complex. This study aimed to evaluate if topo IIα, gp170, bcl-2, tumor burden and histology could predict the response to NACT in locally advanced STS of the extremities. Methods: Twenty-nine patients with STS of the extremities (median age 61 yrs, range 35-82) received a median of 3 cycles of Epirubicine and Ifosfamide as NACT. Topo IIα, gp170, bcl-2 were assessed by IHC either on pre-treatment biopsies and on post-treatment surgical specimens. Bioptical specimens were categorized in low and high expression according to a cut-off corresponding to the median value ...

Background Magnetic resonance arthrography (MRA) is commonly used to demonstrate injury to the labrum and hyaline cartilage in patients with femoroacetabular impingement (FAI). The purpose of this study was to assess the diagnostic correlation between MRA and findings at arthroscopic and open surgery. Materials and methods MRA reports of 41 hips with symptomatic FAI were reviewed and compared with subsequent intraoperative findings (n = 21 surgical dislocations and n = 20 therapeutic hip arthroscopies). Each case was assessed for the presence of a cam deformity, a cartilage lesion of the femoral head, an os acetabuli, an injury to the labrum and injury to the acetabular cartilage. Results were collected prospectively in a cross-table and analysed retrospectively for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results The sensitivity, specificity, PPV and NPV in the presence of reported cam-type deformity or an os acetabuli were 100 %. In the presence of cartilage lesions of the femoral head, the values were 46, 81, 55 and 73 %, respectively. For labral tears, the values were 91, 86, 97 and 67 %. In the presence of acetabular cartilage injuries, the values were 69, 88, 78 and 81 %, respectively. Conclusions MRA appears to be an efficacious imaging modality in the evaluation of labral tears, cam-type impingement lesions and os acetabuli of the hip. MRA is less efficacious in the diagnosis of cartilage abnormalities in the hip, both femoral and acetabular. Researchers should focus on further improvements in imaging techniques in order to give reliable preoperative information to the surgeon.

Radiology has an important part to play in Goodpasture's syndrome. The radio-sympatomatological value of lung changes are clarified and subdivided into primary, secondary and mixed, and mention made of the possible significance of cardiomegaly, where present. Special attention is paid to the importance of radiological exploration of the kidneys for the recognition of changes whose concomitance with lung changes may suggest diagnosis of Goodpasture's syndrome.

A brief report of two cases of Goodpasture's pneumonephrotoxic syndrome offers the greatest contribution that can be given by renal radiographic signs obtained by contrast radiography. Their association with already known pulmonary signs helps diagnosis and is an absolute indication for nephrobiopsy.

The oxidation of alcohols to aldehydes and ketones by air or oxygen under mild conditions (room temperature and atmospheric pressure), catalysed by persistent and non-persistent nitroxyl radicals in combination with transition metal salts, appears to be the most convenient of the numerous processes developed for these purposes. The thermochemistry, the kinetics, and the Hammett correlations have allowed us to establish, on a quantitative basis, the fundamental difference between the oxidation catalysed by persistent and non-persistent nitroxyl catalysts. In the latter case, an interesting significant captodative effect is displayed for the first time for the oxidation of substituted benzyl alcohols; the importance of enthalpic and polar effects is emphasised. (© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2004)